Health care may be the only major sector of our economy where consumers frequently don’t know how much a service costs until after they’ve bought it.
The Everett Clinic is working to change that. The Snohomish County health-care system is posting its prices online for anyone to browse. It’s believed to be the first big provider in the region to make this information so readily available.
“Health care costs too much,” said Al Fisk, the clinic’s chief medical officer. “And consumers are increasingly paying a larger share of the costs personally.”
Health-insurance plans are ratcheting up their deductibles, the amount people must spend out of pocket before their insurance company begins paying the bills. There are larger co-payments or coinsurance, which also are paid by the patients themselves.
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But most doctors, clinics and hospitals don’t publish their prices. Patients can request the information, but it can be difficult to get and many people don’t think of asking or don’t know how to.
And prices vary dramatically. The cost of a tonsillectomy or cataract surgery at a major hospital, for example, can be twice as expensive as the price at a clinic specializing in the procedure.
When patients don’t know what something costs, they can’t shop for the best prices and services. There’s little incentive for high-end providers to lower their prices.
“The market doesn’t work very well if the prices aren’t transparent,” Fisk said.
The Everett Clinic’s online prices are the “retail” prices it charges the uninsured, though it offers discounts for prompt payments. Insurance companies negotiate their own prices for what they will pay the provider, but that information is confidential. Generally speaking, the insurers are paying less than retail.
Some insurance companies have online tools that allow their own customers to search for the negotiated prices with different providers, and often the tool includes added information about the customers’ deductibles.
For now, The Everett Clinic is posting only prices for imaging services, such as X-rays and MRIs. But Fisk said it will keep adding procedures to the list. The website also tells patients to call for information on services not listed.
Even with the limitations of the clinic’s data, “It sends a signal to their patients to talk to them about cost,” said Mary McWilliams, executive director of the Washington Health Alliance, a nonprofit supporting health-care reform.
“It’s a very important development,” she said, “that they understand that patients want to know more about costs and the system needs to be more transparent.”
During the recent legislative session, Washington lawmakers approved new transparency rules, including a law requiring all of the state’s insurance companies to create cost and quality tools for customers by January 2016.
Lawmakers also voted for an “All-Payer Claims Database,” compiling price and performance data for providers and available for anyone to use. Similar databases exist or are being built in about a dozen states.
Washington’s largest insurance providers — Premera Blue Cross and Regence BlueShield — initially fought the proposal. They objected to disclosing their negotiated prices, so the database will contain only costs from Medicaid and insurance covering state employees, though supporters hope it eventually will be expanded.
Fisk believes transparency will force health-care providers to be more competitive and cut wasteful spending, including unnecessary diagnostic tests and prescribing of name-brand drugs in situations where generics work just as well.
“We’re working hard to eliminate the waste,” he said, “and you improve quality and lower the cost.”
Lisa Stiffler, a freelance writer in Seattle, can be reached at email@example.com.This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation.